Exploring the Context and Implementation of Public Health Regulations Governing Sex Work: A Qualitative Study with Migrant Sex Workers in Guatemala

Abstract

Public health regulations practices surrounding sex work and their enforcement can have unintended consequences for HIV and sexually transmitted infection (STI) prevention and care among sex workers. This analysis was based on qualitative in-depth (n = 33) and focus groups interviews (n = 20) conducted with migrant female sex workers in Tecún Umán and Quetzaltenango, Guatemala, and explored the implementation of sex work regulations and related consequences for HIV prevention and care among migrant sex workers. Sex work regulations were found to have health-related benefits (e.g., access to HIV/STI testing) as well as negative impacts, such as abuse by police and harassment, detention/deportation of migrant sex workers. Whereas public health regulations may improve access to HIV/STI testing, their implementation may inadvertently jeopardize sex workers' health through unintended negative consequences. Non-coercive, evidence-based public health and sex work policies and programs are needed to expand access to HIV/STI prevention and care among migrant sex workers, while protecting their dignity and human rights.

Migration, violence, and safety among migrant sex workers: a qualitative study in two Guatemalan communities

“…In Tecún Úman, sex workers must also have their card stamped and verified by police after each clinic visit. These social mechanisms of abuse of power constrain sex workers’ agency surrounding their own health and safety (Rocha-Jiménez et al 2014; Wingood and DiClemente 2000)…”

Stigma and unmet sexual and reproductive health needs among international migrant sex workers at the Mexico–Guatemala border

“…24 A shift to a rights-based approach emphasizing the protection of sex workers' human rights and broader social well-being is critically needed. 7,18 The present study has several limitations. Our qualitative research does not represent the experiences of all migrant sex workers in the Mexico-Guatemala border region or elsewhere, and future studies exploring other experiences that may be relevant to migrant sex workers' SRH needs and access are recommended.…”

“…Although many local organizations (Médicos del Mundo; Una Mano Amiga in Tapachula, Mexico; and Educación para la Vida [EDUCAVIDA] in Guatemala) have advocated the inclusion of SRH services (for example, Pap smears) as part of sex workers' regular visits to municipal clinics, barriers to such integration persist, including limited resources and funding models that continue to prioritize vertical, disease‐specific interventions . A shift to a rights‐based approach emphasizing the protection of sex workers' human rights and broader social well‐being is critically needed …”

“…Interviews and field notes were initially organized and coded according to the major themes that emerged in the transcripts, such as key health concerns and access to healthcare. Given the paucity of literature pertaining to the experiences of migrant sex workers with regard to access to SRH services in the study sites, a primarily inductive analysis approach guided by the participants' own narratives was adopted…”

“…18 Women who exchange sex in informal venues (for example, street/hotels) often do not maintain a health card. 18 In Tecún Umán and Quetzaltenango, health permits are provided free of charge through community health clinics. In Tapachula, obtaining a health card involves out-of-pocket fees and requires transportation to a clinic located in an isolated outlying area (Las Huacas).…”